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Tam ACT, Steck VA, Janjua S, Liu TY, Murphy RA, Zhang W, Conklin AI. A systematic review of evidence on employment transitions and weight change by gender in ageing populations. PLoS One 2022; 17:e0273218. [PMID: 35981079 PMCID: PMC9387864 DOI: 10.1371/journal.pone.0273218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 08/04/2022] [Indexed: 11/29/2022] Open
Abstract
Background Becoming unemployed is associated with poorer health, including weight gain. Middle- and older-age adults are a growing segment of workforces globally, but they are also more vulnerable to changes to employment status, especially during economic shocks. Expected workforce exits over the next decade may exacerbate both the obesity epidemic and the economic burden of obesity. This review extends current knowledge on economic correlates of health to assess whether employment transitions impact body weight by sex/gender among middle-aged and older adults. Methods Eight bibliometric databases were searched between June and July 2021, supplemented by hand-searches, with no restriction on publication date or country. Longitudinal studies, or reviews, were eligible when examining body weight as a function of employment status change in adults ≥50 years. Data extraction and quality appraisal used predefined criteria; reported findings were analysed by narrative synthesis. Results We screened 6,001 unique abstracts and identified 12 articles that met inclusion criteria. All studies examined retirement; of which two also examined job-loss. Overall, studies showed that retirement led to weight gain or no difference in weight change compared to non-retirees; however, reported effects were not consistent for either women or men across studies or for both women and men within a study. Reported effects also differed by occupation: weight gain was more commonly observed among retirees from physical occupations but not among retirees from sedentary occupations. Few studies assessed the role of health behaviours; sleep was the least studied. Most studies were medium quality. Conclusions Existing studies do not provide a clear enough picture of how employment transitions affect body weight. Firm conclusions on the impact of employment transitions on weight cannot be made without further high-quality evidence that considers the role of gender, job-type, other health behaviours, and other transitions, like job-loss.
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Affiliation(s)
- Alexander C. T. Tam
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- * E-mail:
| | - Veronica A. Steck
- Faculty of Science, Department of Life Sciences, McGill University, Montreal, Quebec, Canada
| | - Sahib Janjua
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ting Yu Liu
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rachel A. Murphy
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Cancer Control Research, BC Cancer Research Institute, Vancouver, British Columbia, Canada
| | - Wei Zhang
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Research, Vancouver, British Columbia, Canada
| | - Annalijn I. Conklin
- Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Research, Vancouver, British Columbia, Canada
- Faculty of Pharmaceutical Sciences, Collaboration for Outcomes Research and Evaluation (CORE), University of British Columbia, Vancouver, British Columbia, Canada
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Birgisdóttir KH, Hauksdóttir A, Ruhm C, Valdimarsdóttir UA, Ásgeirsdóttir TL. The effect of the economic collapse in Iceland on the probability of cardiovascular events. ECONOMICS AND HUMAN BIOLOGY 2020; 37:100861. [PMID: 32106017 DOI: 10.1016/j.ehb.2020.100861] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 02/03/2020] [Accepted: 02/03/2020] [Indexed: 06/10/2023]
Abstract
After several years of a booming economy in Iceland, the economic bubble burst in 2008 and affected most Icelanders in one way or another. We explore whether the economic collapse in 2008 and subsequent economic crisis affected the probability of ischemic heart disease (IHD) events, independent of regular cyclical effects that can be attributed to typical economic conditions. Moreover, we conduct a mediation analysis to study the potential mechanisms through which the relationship between the economic collapse and cardiovascular health travels. We estimate linear probability models using administrative data on IHD events, earnings and balance-sheet status, as well as unemployment for all Icelanders aged 16 and older in 2000-2014. We find that the sharp change in economic conditions in 2008 increased the probability of cardiovascular events in both males and females in the long term. In absolute terms, these effects were small in magnitude but often statistically significant, amounting to approximately 13-16 extra cases of IHD events in each of the two years following the collapse for males and 3-5 addition cases for females. Moreover, they contrast with the finding that general business-cycle fluctuations operated in the opposite direction. Several potential mediators were correlated with the probability of IHD events, but their inclusion had little impact on the estimated effects of the economic crisis. A statistically significant business-cycle effect is found for both genders indicating that in general, harder economic times are beneficial for heart health. Thus, the general business cycle and the economic collapse in 2008 and subsequent crisis can be thought of as separate phenomena with differing effects on IHD.
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Affiliation(s)
- Kristín Helga Birgisdóttir
- Faculty of Economics, University of Iceland, Reykjavik, Iceland, Oddi v/Sturlugötu, 101 Reykjavík, Iceland.
| | - Arna Hauksdóttir
- Faculty of Medicine, Center of Public Health Sciences, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Christopher Ruhm
- Frank Batten School of Leadership and Public Policy, University of Virginia, VA, USA
| | - Unnur Anna Valdimarsdóttir
- Faculty of Medicine, Center of Public Health Sciences, School of Health Sciences, University of Iceland, Reykjavik, Iceland; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm Sweden; Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
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3
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Everding J, Marcus J. The effect of unemployment on the smoking behavior of couples. HEALTH ECONOMICS 2020; 29:154-170. [PMID: 31820539 DOI: 10.1002/hec.3961] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/11/2019] [Accepted: 09/13/2019] [Indexed: 06/10/2023]
Abstract
Although unemployment likely entails various externalities, research examining its spillover effects on spouses is scarce. This is the first paper to estimate effects of unemployment on the smoking behavior of both spouses. Using German Socio-Economic Panel data, we combine matching and difference-in-differences estimation, employing the post-double-selection method for control variable selection via Lasso regressions. One spouse's unemployment increases both spouses' smoking probability and intensity. Smoking relapses and decreased smoking cessation drive the effects. Effects are stronger if the partner already smokes and if the male partner becomes unemployed. Of several mechanisms discussed, we identify smoking to cope with stress as relevant.
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Affiliation(s)
- Jakob Everding
- Hamburg Center for Health Economics, Universität Hamburg, Hamburg, Germany
| | - Jan Marcus
- Hamburg Center for Health Economics, Universität Hamburg, Hamburg, Germany
- Education and Family Department, DIW Berlin, Berlin, Germany
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4
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The association between economic uncertainty and suicide in the short-run. Soc Sci Med 2019; 220:403-410. [DOI: 10.1016/j.socscimed.2018.11.035] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 10/03/2018] [Accepted: 11/23/2018] [Indexed: 11/21/2022]
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Jofre-Bonet M, Serra-Sastre V, Vandoros S. The impact of the Great Recession on health-related risk factors, behaviour and outcomes in England. Soc Sci Med 2018; 197:213-225. [DOI: 10.1016/j.socscimed.2017.12.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 11/29/2017] [Accepted: 12/11/2017] [Indexed: 12/26/2022]
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Ásgeirsdóttir TL, Jóhannsdóttir HM. Income-related inequalities in diseases and health conditions over the business cycle. HEALTH ECONOMICS REVIEW 2017; 7:12. [PMID: 28275988 PMCID: PMC5342994 DOI: 10.1186/s13561-017-0150-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 02/27/2017] [Indexed: 05/19/2023]
Abstract
How business cycles affect income-related distribution of diseases and health disorders is largely unknown. We examine how the prevalence of thirty diseases and health conditions is distributed across the income spectrum using survey data collected in Iceland in 2007, 2009 and 2012. Thus, we are able to take advantage of the unusually sharp changes in economic conditions in Iceland during the Great Recession initiated in 2008 and the partial recovery that had already taken place by 2012 to analyze how income-related health inequality changed across time periods that can be described as a boom, crisis and recovery. The concentration curve and the concentration index are calculated for each disease, both overall and by gender. In all cases, we find a considerable income-related health inequality favoring higher income individuals, with a slight increase over the study period. Between 2007 and 2009, our results indicate increased inequality for women but decreased inequality for men. Between 2009 and 2012 on the contrary, men's inequality increases but women's decreases. The overarching result is thus that the economic hardship of the crisis temporarily increased female income-related health inequality, but decreased that of men.
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Birgisdóttir KH, Jónsson SH, Ásgeirsdóttir TL. Economic conditions, hypertension, and cardiovascular disease: analysis of the Icelandic economic collapse. HEALTH ECONOMICS REVIEW 2017; 7:20. [PMID: 28536969 PMCID: PMC5442036 DOI: 10.1186/s13561-017-0157-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 05/15/2017] [Indexed: 06/07/2023]
Abstract
Previous research has found a positive short-term relationship between the 2008 collapse and hypertension in Icelandic males. With Iceland's economy experiencing a phase of economic recovery, an opportunity to pursue a longer-term analysis of the collapse has emerged. Using data from a nationally representative sample, fixed-effect estimations and mediation analyses were performed to explore the relationship between the Icelandic economic collapse in 2008 and the longer-term impact on hypertension and cardiovascular health. A sensitivity analysis was carried out with pooled logit models estimated as well as an alternative dependent variable. Our attrition analysis revealed that results for cardiovascular diseases were affected by attrition, but not results from estimations on the relationship between the economic crisis and hypertension. When compared to the boom year 2007, our results point to an increased probability of Icelandic women having hypertension in the year 2012, when the Icelandic economy had recovered substantially from the economic collapse in 2008. This represents a deviation from pre-crisis trends, thus suggesting a true economic-recovery impact on hypertension.
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Affiliation(s)
| | - Stefán Hrafn Jónsson
- Faculty of Social and Human Sciences, University of Iceland, Oddi v/Sturlugotu, 101 Reykjavik, Iceland
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9
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Hughes A, Kumari M. Unemployment, underweight, and obesity: Findings from Understanding Society (UKHLS). Prev Med 2017; 97:19-25. [PMID: 28034731 DOI: 10.1016/j.ypmed.2016.12.045] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 12/20/2016] [Accepted: 12/23/2016] [Indexed: 01/09/2023]
Abstract
Elevated morbidity and mortality among jobseekers may be partly explained by adiposity, but previous studies of unemployment and body mass index (BMI), which have usually modelled associations as linear, have produced inconsistent results. However, both underweight and obesity are associated with mortality, and both weight loss and weight gain associated with a stressful environment. If unemployment is associated with both underweight and obesity for different subgroups, these associations may previously have masked each other, whilst affecting health through divergent pathways. We investigated whether there is a previously overlooked U-shaped association of unemployment and BMI, which could help explain jobseekers' elevated morbidity and mortality, and identify groups vulnerable to underweight and obesity during unemployment. We used multinomial models to simultaneously investigate associations of unemployment with BMI-defined underweight, overweight, and obesity in 10,737 working-age UK adults from Understanding Society (UKHLS) in 2010-12. Moderating impacts of unemployment duration, demographic factors and smoking were explored. Current jobseekers were more likely to be underweight (Odds ratio (OR): 4.05, 95% confidence interval (CI): 2.12-7.73) and less likely to be overweight (OR: 0.71, CI: 0.55, 0.92) adjusted for gender, age, education, health, smoking and physical activity, while unemployed non-smokers had increased odds of obesity (OR: 1.52, CI: 1.06-2.18). Underweight and overweight associations were more apparent for longer-term jobseekers, men, and jobseekers from lower-income households. We conclude that unemployment is associated with underweight and, in nonsmokers, obesity. Results show the unemployment-adiposity relationship cannot be properly studied assuming unidirectionality of effects, and suggest unemployment may affect health of different groups via divergent adiposity-mediated pathways.
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Affiliation(s)
- Amanda Hughes
- Institute for Social and Economic Research, University of Essex, Wivenhoe Park, Colchester, Essex CO4 3SQ, UK.
| | - Meena Kumari
- Institute for Social and Economic Research, University of Essex, Wivenhoe Park, Colchester, Essex CO4 3SQ, UK.
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Karanikolos M, Heino P, McKee M, Stuckler D, Legido-Quigley H. Effects of the Global Financial Crisis on Health in High-Income Oecd Countries. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2016; 46:208-40. [DOI: 10.1177/0020731416637160] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
A growing body of evidence documents how economic crises impact aspects of health across countries and over time. We performed a systematic narrative review of the health effects of the latest economic crisis based on studies of high-income countries. Papers published between January 2009 and July 2015 were selected based on review of titles and abstracts, followed by a full text review conducted by two independent reviewers. Ultimately, 122 studies were selected and their findings summarized. The review finds that the 2008 financial crisis had negative effects on mental health, including suicide, and to a varying extent on some non-communicable and communicable diseases and access to care. Although unhealthy behaviors such as hazardous drinking and tobacco use appeared to decline during the crisis, there have been increases in some groups, typically those already at greatest risk. The health impact was greatest in countries that suffered the largest economic impact of the crisis or prolonged austerity. The Great Recessions in high-income countries have had mixed impacts on health. They tend to be worse when economic impacts are more severe, prolonged austerity measures are implemented, and there are pre-existing problems of substance use among vulnerable groups.
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Affiliation(s)
- Marina Karanikolos
- Europe an Observatory on Health Systems and Policies, London, United Kingdom
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Pia Heino
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- University of Helsinki, Helsinki, Finland
| | - Martin McKee
- Europe an Observatory on Health Systems and Policies, London, United Kingdom
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David Stuckler
- Department of Sociology, University of Oxford, Oxford, United Kingdom
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- London School of Hygiene and Tropical Medicine, London, UK
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Bacigalupe A, Shahidi FV, Muntaner C, Martín U, Borrell C. Why is There so Much Controversy Regarding the Population Health Impact of the Great Recession? Reflections on Three Case Studies. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2015; 46:5-35. [DOI: 10.1177/0020731415611634] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
In the aftermath of the Great Recession, public health scholars have grown increasingly interested in studying the health consequences of macroeconomic change. Reflecting existing debates on the nature of this relationship, research on the effects of the recent economic crisis has sparked considerable controversy. On the one hand there is evidence to support the notion that macroeconomic downturns are associated with positive health outcomes. On the other hand, a growing number of studies warn that the current economic crisis can be expected to pose serious problems for the public’s health. This article contributes to this debate through a review of recent evidence from three case studies: Iceland, Spain, and Greece. It shows that the economic crisis has negatively impacted some population health indicators (e.g., mental health) in all three countries, but especially in Greece. Available evidence defies deterministic conclusions, including increasingly “conventional” claims about economic downturns improving life expectancy and reducing mortality. While our results echo previous research in finding that the relationship between economic crises and population health is complex, they also indicate that this complexity is not arbitrary. On the contrary, changing social and political contexts provide meaningful, if partial, explanations for the perplexing nature of recent empirical findings.
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Affiliation(s)
- Amaia Bacigalupe
- Department of Sociology 2, University of the Basque Country (UPV/EHU), Leioa, Spain
- OPIK-Research Group on Social Determinants of Health and Demographic Change
| | - Faraz Vahid Shahidi
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Carles Muntaner
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Bloomberg School of Nursing, University of Toronto, Toronto, Ontario, Canada
- Department of Public Health Sciences, Korea University
| | - Unai Martín
- Department of Sociology 2, University of the Basque Country (UPV/EHU), Leioa, Spain
- OPIK-Research Group on Social Determinants of Health and Demographic Change
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, Barcelona 08023, Spain
- Ciber de Epidemiología y Salud Pública, 28029, Spain
- Universitat Pompeu Fabra, Barcelona 08003, Spain
- Institut de Recerca Biomèdica Sant Pau (IIB Sant Pau), Barcelona 08025, Spain
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Eiríksdóttir VH, Valdimarsdóttir UA, Ásgeirsdóttir TL, Gísladóttir A, Lund SH, Hauksdóttir A, Zoëga H. Smoking and obesity among pregnant women in Iceland 2001-2010. Eur J Public Health 2015; 25:638-43. [PMID: 25829507 DOI: 10.1093/eurpub/ckv047] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The prevalence of smoking during pregnancy in Western societies has decreased in the last decades, whereas prevalence of overweight and obesity has increased. Our objective was to study secular trends and patterns of smoking and body weight among pregnant women in Iceland, during a period of dramatic changes in the nation's economy. METHODS On the basis of the Medical Birth Registry, we used a random sample of 1329 births between 1 January 2001 and 31 December 2010. Information on smoking, body mass index and background factors during pregnancy was retrieved from the Medical Birth Register and maternity records. Trends in smoking, overweight, obesity and body mass index were assessed using logistic and linear regression analyses. Logistic regression analysis was used to examine the annual odds of smoking and obesity and by socio-demographic characteristics. RESULTS We found a decrease in the prevalence of continued smoking during pregnancy from 12.4% in 2001 to 7.9% in 2010 [odds ratio (OR) = 0.94, 95% confidence interval (CI) (0.88-1.00)], particularly among women with Icelandic citizenship [OR = 0.92, 95% CI (0.86-0.98)], whereas no changes in obesity [OR = 1.02, 95% CI (0.96-1.07)] were observed. The highest prevalence of maternal smoking and obesity was observed in 2005-06. CONCLUSION Our results indicate that smoking during pregnancy decreased among Icelandic women in 2001-10, whereas an initial increase in obesity prevalence seemed to level off towards the end of the observation period. Interestingly, we found that both of these maternal risk factors reached their highest prevalence in 2005-06, which coincides with a flourishing period in the nation's economy.
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Affiliation(s)
- Védís H Eiríksdóttir
- 1 Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Unnur A Valdimarsdóttir
- 1 Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland 2 Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | | | - Agnes Gísladóttir
- 1 Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Sigrún H Lund
- 1 Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Arna Hauksdóttir
- 1 Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Helga Zoëga
- 1 Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
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Cutler DM, Huang W, Lleras-Muney A. When does education matter? The protective effect of education for cohorts graduating in bad times. Soc Sci Med 2015; 127:63-73. [PMID: 25113567 PMCID: PMC4886722 DOI: 10.1016/j.socscimed.2014.07.056] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 07/18/2014] [Accepted: 07/25/2014] [Indexed: 11/21/2022]
Abstract
Using Eurobarometer data, we document large variation across European countries in education gradients in income, self-reported health, life satisfaction, obesity, smoking and drinking. While this variation has been documented previously, the reasons why the effect of education on income, health and health behaviors varies is not well understood. We build on previous literature documenting that cohorts graduating in bad times have lower wages and poorer health for many years after graduation, compared to those graduating in good times. We investigate whether more educated individuals suffer smaller income and health losses as a result of poor labor market conditions upon labor market entry. We confirm that a higher unemployment rate at graduation is associated with lower income, lower life satisfaction, greater obesity, more smoking and drinking later in life. Further, education plays a protective role for these outcomes, especially when unemployment rates are high: the losses associated with poor labor market outcomes are substantially lower for more educated individuals. Variation in unemployment rates upon graduation can potentially explain a large fraction of the variance in gradients across different countries.
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Affiliation(s)
- David M Cutler
- Harvard University and NBER, 1875 Cambridge Street, Cambridge, MA 02138, USA.
| | - Wei Huang
- Harvard University and NBER, 1050 Massachusetts Avenue, Cambridge, MA 02138, USA.
| | - Adriana Lleras-Muney
- Department of Economics and NBER, 9373 Bunche Hall, UCLA, Los Angeles, CA 90095, USA.
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Asgeirsdóttir TL, Ragnarsdóttir DO. Health-income inequality: the effects of the Icelandic economic collapse. Int J Equity Health 2014; 13:50. [PMID: 25063235 PMCID: PMC4119249 DOI: 10.1186/1475-9276-13-50] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 02/06/2014] [Indexed: 11/23/2022] Open
Abstract
Introduction Health-income inequality has been the focus of many studies. The relationship between economic conditions and health has also been widely studied. However, not much is known about how changes in aggregate economic conditions relate to health-income inequality. Nevertheless, such knowledge would have both scientific and practical value as substantial public expenditures are used to decrease such inequalities and opportunities to do so may differ over the business cycle. For this reason we examine the effect of the Icelandic economic collapse in 2008 on health-income inequality. Methods The data used come from a health and lifestyle survey carried out by the Public Health Institute of Iceland in 2007 and 2009. A stratified random sample of 9,807 individuals 18–79 years old received questionnaires and a total of 42.1% answered in both years. As measures of health-income inequality, health-income concentration indices are calculated and decomposed into individual-level determinants. Self-assessed health is used as the health measure in the analyses, but three different measures of income are used: individual income, household income, and equivalized household income. Results In both years there is evidence of health-income inequality favoring the better off. However, changes are apparent between years. For males health-income inequality increases after the crisis while it remains fairly stable for females or slightly decreases. The decomposition analyses show that income itself and disability constitute the most substantial determinants of inequality. The largest increases in contributions between years for males come from being a student, having low education and being obese, as well as age and income but those changes are sensitive to the income measure used. Conclusions Changes in health and income over the business cycle can differ across socioeconomic strata, resulting in cyclicality of income-related health distributions. As substantial fiscal expenditures go to limiting the relationship between income and health, the business-cycle effect on equality, which has up until now not received much attention, needs to be considered.
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